Scholtz Smita, Piper Cornelia, Horstkotte Dieter, Furukawa Nobuyuki, Börgermann Jochen, Gummert Jan, Rudolph Tanja K, Rudolph Volker, Scholtz Werner
Herz- und Diabeteszentrum NRW, Clinic for General and Interventional Cardiology/Angiology, Georgstr. 11, D-32545 Bad Oeynhausen, Germany.
J Invasive Cardiol. 2019 Sep;31(9):260-264.
Transcatheter aortic valve implantation (TAVI) has become standard therapy for aortic stenosis patients with intermediate or high operative risk. Treatment of patients with pre-existing mechanical mitral valve replacement (MVR) is challenging due to possible interference between the TAVI prosthesis and MVR. We present our single-center experience with this special patient cohort.
A total of 1960 patients underwent TAVI at our institution between 2009 and March 2018; of these, 16 patients had pre-existing mechanical MVR. Device success and adverse events were analyzed according to the Valve Academic Research Consortium (VARC)-2 criteria. Patients were followed for at least 12 months.
Mean patient age was 81.5 ± 4.4 years. The patients had a mean logistic EuroScore of 37.1 ± 13.5% and STS score of 7.1 ± 3.2%. Successful valve deployment was achieved in all patients, peri-interventional stroke rate was 0.0%, and permanent pacemaker was implanted in 2 patients (12.5%). Two patients experienced major complications, with blockage of the MVR disc in 1 patient and annulus rupture in 1 patient. Hence, 30-day mortality was 12.5% and 1-year mortality was 25.0%.
TAVI in patients with mechanical MVR is challenging and requires careful preparation and choice of TAVI device. Repositionable and retrievable devices seem to be a safer option.
经导管主动脉瓣植入术（TAVI）已成为手术风险中或高的主动脉瓣狭窄患者的标准治疗方法。对于已有机械二尖瓣置换术（MVR）的患者进行治疗具有挑战性，因为TAVI假体与MVR之间可能存在干扰。我们介绍了我们在这一特殊患者群体中的单中心经验。
2009年至2018年3月期间，共有1960例患者在我们机构接受了TAVI；其中，16例患者已有机械MVR。根据瓣膜学术研究联盟（VARC）-2标准分析手术成功率和不良事件。对患者进行至少12个月的随访。
患者平均年龄为81.5±4.4岁。患者的平均逻辑欧洲心脏手术风险评估系统（EuroScore）评分为37.1±13.5%，胸外科医师协会（STS）评分为7.1±3.2%。所有患者均成功植入瓣膜，围手术期卒中发生率为0.0%，2例患者（12.5%）植入了永久性起搏器。2例患者出现严重并发症，1例患者MVR瓣片阻塞，1例患者瓣环破裂。因此，30天死亡率为12.5%，1年死亡率为25.0%。
对已有机械MVR的患者进行TAVI具有挑战性，需要仔细准备并选择TAVI设备。可重新定位和可回收的设备似乎是更安全的选择。
